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Prise en charge médicale per- et postnatale de la hernie congénitale diaphragmatique

Perinatal and postnatal management of congenital diaphragmatic hernia

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Revue de médecine périnatale

Résumé

Malgré les progrès de la réanimation, la mortalité néonatale des enfants porteurs de HCD reste élevée, proche de 30–40 %, essentiellement du fait de l’hypoplasie pulmonaire et d’une hypertension artérielle pulmonaire. Les principales séquelles observées sont respiratoires (HTAP chronique, dysplasie bronchopulmonaire, susceptibilité aux infections virales), digestives (reflux gastro-oesophagien, trouble de l’oralité), nutritionnelles (dénutrition d’origine multifactorielle: RGO, trouble de l’oralité, insuffisance respiratoire) et orthopédiques (scoliose). La prise en charge actuelle de ces complications est tardive: elle nécessite une intervention plus précoce, qui doit débuter dès la période néonatale. Les objectifs de la prise en charge médicale seront: 1) d’assurer une oxygénation tissulaire et la décarboxylation tout en minimisant le baro-volotraumatisme du poumon; 2) d’assurer une fonction circulatoire adéquate en limitant les conséquences de l’HTAP; 3) de prévenir la morbidité respiratoire et digestive. Elle nécessite impérativement un suivi et une prise en charge multidisciplinaire spécialisée, du fait de l’intrication de ces différentes complications.

Abstract

Despite improvements in intensive care, lung hypoplasia and persistent pulmonary hypertension cause a high mortality rate in newborns with CDH. Sequelae including bronchopulmonary dysplasia, chronic pulmonary hypertension, gastro-oesophageal reflux, growth retardation and oral aversion are observed in half the surviving infants. The aims of post-natal management are: 1) to provide adequate tissular oxygenation and decarboxylation, with minimal lung volo-or barotrauma; 2) to optimise circulatory function through PPHN management; 3) to prevent respiratory and nutritional morbidity. Long-term follow-up and multidisciplinary management are required.

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Authors and Affiliations

  1. Site de Lille, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, F-59037, Lille cedex, France

    L. Storme, T. Rakza, R. Sfeir, E. Aubry, T. Pennaforte, M. Bonnevalle, P. Deruelle, V. Houfflin-Debarge, P. Vaast, P. Fayoux, M. H. Depoortère, B. Soulignac, N. Norel, A. Deschildre, C. Thumerelle, D. Guimber, F. Gottrand & S. Joriot

  2. Site de Paris, hôpital Necker-Enfant-Malades, APHP, 149, rue de Sèvres, F-75015, Paris, France

    A. Benachi

  3. Site de Marseille, CHU de Marseille, 147, boulevard Baille, F-13005, Marseille, France

    P. De Lagausie

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  1. L. Storme
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  2. T. Rakza
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Pour le centre de référence « hemie diaphragmatique congénitale »

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Storme, L., Rakza, T., Sfeir, R. et al. Prise en charge médicale per- et postnatale de la hernie congénitale diaphragmatique. Rev. med. perinat. 1, 26–36 (2009). https://doi.org/10.1007/s12611-009-0008-5

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